Experimental Design (Public): [In public domain]
We applied a cluster randomized design to assess the effect of the intensified IEC campaign on latrine adoption in two selected blocks of Bhadrak district in Orissa. This was felt to be the best experimental design because social mobilization is essentially an attempt to achieve group consensus and move social norms by targeting entire communities, not just individuals.
Based on Community Led Total Sanitation (CLTS) approach in many parts of rural Asia, project team developed an intensified information, education and communication (IEC) campaign. This approach was further informed by in-depth interviews and focus groups with state and local government officials, village residents and key informants. The interviews revealed the importance of social marketing tools must go beyond merely providing "information" on health and in addition, focus on education and communication about the need for a strong, sustained and widely-accepted commitment to improve sanitation. Our discussions showed that it was critical to secure the support of district administrators, public health engineers and nongovernmental organizations (NGOs), as well as to train government civil engineers in social engineering. These preparation activities also suggested that any effective IEC effort must look beyond health to the privacy, dignity and safety benefits to women from using latrines. By changing knowledge, attitudes and practices (the "software"), rather than simply providing a latrine (the "hardware"), the community-led total sanitation approach empowers local people to analyze the magnitude and risk of the environmental pollution caused by open defecation. Examples of social mobilization in treatment villages include: a "walk of shame" (the main consciousness-raising exercise), defecation mapping and core feacal counts. The first was primarily comprised of a community walk aimed at drawing attention to poor hygiene and triggering a collective emotional response. The second invovled a set of participatory exercises that sought to identify the spatial distribution of defecation behaviours and to demonstrate the external effects of poor hygiene on the entire village. The third, which also serves to explain external consequences, involves determining and discussing the volume of faecal matter accumulated in a village. Subsidies were not randomly assigned. Rather, they were available only to poor households because the campaign was implemented within the framework of the Government of India's nationwide Total Sanitation Campaign, which recognizes that income constrains many households in rural areas. Constructing the off-pit latrines promoted under this campaign was prohibitively costly at about 2000 rupees (Rs) per laterine (equal to about 50 US$). Thus, following Total Sanitation Campaign policies, households below the poverty line (with a monthly per capita consumption expenditure of Rs 356) were only required to pay Rs 300 (or US$ 7.5) to build a latrine, whereas other households had to pay the full price. In each of 20 intervention villages, the intervention typically lasted between 1 to 2 weeks; the entire campaign lasted between February and April 2006. To ensure that social mobilization was conducted with sensitivity to local customs, in each village a local community-based organization – which had a prior agreement with state Water and Sanitation Mission - helped with implementation of the intervention, including establishing sanitation marts, procuring latrine components for the village and provide know-how on latrine engineering. A similar mobilization protocol was followed across the 20 intervention villages to achieve the same goal: a community able to analyze its sanitation situation and agree to end open defecation.